Farewell AMA - Pulm/CC fellow

[Donald Juan]

Sorry to be off topic, just saw this video and wanted to share. Completely unrelated to current thread.

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[235009]

Hey everyone, for my upcoming 10-year anniversary of being on SDN I'm reviving this thread. I'm now a 3rd year pulm/crit care fellow at a top program. My career goal is academic medicine. Since the last time I regularly responded to this thread I was awarded two grants (F32 and NIH loan repayment), have published two new first author pubs, and am currently writing a K23 grant. Happy to field any and all questions (particularly about IM residency, PCCM fellowship, moonlighting, academic medicine).

EDIT: only back temporarily and intermittently...also will try to steer clear of MD vs DO discussions at all costs

 

[Goro]

Hey everyone, for my upcoming 10-year anniversary of being on SDN I'm reviving this thread. I'm now a 3rd year pulm/crit care fellow at a top program. My career goal is academic medicine. Since the last time I regularly responded to this thread I was awarded two grants (F32 and NIH loan repayment), have published two new first author pubs, and am currently writing a K23 grant. Happy to field any and all questions (particularly about IM residency, PCCM fellowship, moonlighting, academic medicine).

EDIT: only back temporarily and intermittently...also will try to steer clear of MD vs DO discussions at all costs

Welcome back!

When does the faculty job hunt begin? Good luck!

Two words of advice:
1) Deans and Dept't Chairs are paid to lie
2) If it's not written down in your contract, it doesn't exist.

 

[235009]

Welcome back!

When does the faculty job hunt begin? Good luck!

Two words of advice:
1) Deans and Dept't Chairs are paid to lie
2) If it's not written down in your contract, it doesn't exist.

Will be interviewing starting next academic year but am pretty heavily leaning toward staying where I am (for both personal and professional reasons). Thanks for the advice. I have heard #2 very often but also heard that there is very little room for negotiation, particularly at programs who don't need to recruit as aggressively. As for #1...I'll definitely try to be skeptical of what people say.

 

[Lawpy]

Hey everyone, for my upcoming 10-year anniversary of being on SDN I'm reviving this thread. I'm now a 3rd year pulm/crit care fellow at a top program. My career goal is academic medicine. Since the last time I regularly responded to this thread I was awarded two grants (F32 and NIH loan repayment), have published two new first author pubs, and am currently writing a K23 grant. Happy to field any and all questions (particularly about IM residency, PCCM fellowship, moonlighting, academic medicine).

EDIT: only back temporarily and intermittently...also will try to steer clear of MD vs DO discussions at all costs

1. Why academic medicine and not private practice?

2. At what stage did you start pursuing research seriously (i.e. during med school, residency etc.)?

3. What advice would you give to a med student who's interested in IM at a "top" residency program?

 

[precisiongraphic]

EDIT: only back temporarily and intermittently...also will try to steer clear of MD vs DO discussions at all costs

What do you think is the difference between MD and DO?...................kidding!

 

[235009]

1. Why academic medicine and not private practice?

2. At what stage did you start pursuing research seriously (i.e. during med school, residency etc.)?

3. What advice would you give to a med student who's interested in IM at a "top" residency program?

Great questions...
1. Research gets me out of bed in the morning. I get excited about learning something in depth and furthering the knowledge on the subject. I also want to be a leader in the field... writing and shaping the guidelines instead of just following them. I also find it fun and stimulating to work as a team to formulate and execute research questions and go to conferences. Clinical medicine has unfortunately become very tedious and has been completely ruined by administrators and meaningless metrics.

2. I started seriously pursuing research before med school. I did a 2 year MPH at a top program and published a first author pub my second year of med school (all work I did during my MPH). I then got 3 more in residency. The knowledge and skills from the MPH went a long way cause it allowed me to bring something to the table so that my mentor felt like he could invest time and effort in me. That said finding good mentors is absolutely crucial to success in research.

3. Can't really answer this because I didn't go to a "top" program. In fact didn't get interviews at any of the top programs. Basically you have to have two of the following: first quartile class rank, AOA, H in medicine clerkship with a strong letter. I had none of the three. That said you don't have to go to Brigham, MGH or Hopkins to do research in residency and match into a good fellowship. Just go to a solid University program with strong clinical training.

 

[ortnakas]

Hey everyone, for my upcoming 10-year anniversary of being on SDN I'm reviving this thread. I'm now a 3rd year pulm/crit care fellow at a top program. My career goal is academic medicine. Since the last time I regularly responded to this thread I was awarded two grants (F32 and NIH loan repayment), have published two new first author pubs, and am currently writing a K23 grant. Happy to field any and all questions (particularly about IM residency, PCCM fellowship, moonlighting, academic medicine).

EDIT: only back temporarily and intermittently...also will try to steer clear of MD vs DO discussions at all costs

Congratulations on the grant and being a third year! As far as the edit... wise choice.

Question: what advice do you have for an intern starting on ICU? In my particular case, without personal fellowship aspirations and at a shop without pulm/crit fellows, if that makes a difference advice-wise, but general tips are of course also welcome.

 

[jdh71]

Will be interviewing starting next academic year but am pretty heavily leaning toward staying where I am (for both personal and professional reasons). Thanks for the advice. I have heard #2 very often but also heard that there is very little room for negotiation, particularly at programs who don't need to recruit as aggressively. As for #1...I'll definitely try to be skeptical of what people say.

I hope you land that K, but if you don't and get tired of working for 90K/year staffing 5 BMT "will you please bronch," two surgery "doh why is this guy on o2 I want to send him home," and one dyspnea that is heart failure that cards won't admit consults per day, and staffing the weekend/night ICU, you can PM me. We are always looking for solid talent.

 

[jw3600]

I hope you land that K, but if you don't and get tired of working for 90K/year staffing 5 BMT "will you please bronch," two surgery "doh why is this guy on o2 I want to send him home," and one dyspnea that is heart failure that cards won't admit consults per day, and staffing the weekend/night ICU, you can PM me. We are always looking for solid talent.

I understand some of this.

 

[235009]

Congratulations on the grant and being a third year! As far as the edit... wise choice.

Question: what advice do you have for an intern starting on ICU? In my particular case, without personal fellowship aspirations and at a shop without pulm/crit fellows, if that makes a difference advice-wise, but general tips are of course also welcome.

It's 3rd year out of 4 btw, but thanks

Advice for an intern in the ICU: you won't fix the patient by sitting in front of the computer. I know we've all gotten very used to gen med floors where we get pages, put in orders, and write notes all day. Maybe you don't even see a single patient after rounds if you're not admitting. In the ICU you should get up and go to the patient's bedside more often than not when a nurse asks you for something and if they ask you to evaluate a patient you should be there in <5 min. It's also usually the only place where things can happen without an order. You treat the patient first and then the computer. Also ICU nurses have a lot more training than floor nurses, only have one or two patients (often same pt for several days in a row) and you should be including them in your discussions, explaining your thought process and contingencies, and telling them why you're doing something.

So in summary:
1. Take nurses' concerns seriously 100% of the time
2. Be present at the patient's bedside, just putting in an order doesn't cut it
3. Team based approach is key

Incidentally this is also the same formula for having the nurses like you which will in turn mean you'll have a great time in the ICU

Hey doc, welcome back. I’m curious if you considered other fields besides PCCM during your residency years? If so, what made you choose PCCM over those fields. My apologies if you’ve answered this somewhere in this thread, if so could you please direct me to that post.

Went into residency wanting to do ID but very quickly found out that I liked ID research more than ID clinical practice. Considered GI and cards as well but after my MICU rotation intern year I settled on PCCM. I would strongly recommend coming to the decision as early as possible. That way I was able to seek out a research mentor by the end of my intern year. If you don't take any time off after residency there is a very limited period of time before you have to apply to fellowship (August/Sept of 3rd year).

I hope you land that K, but if you don't and get tired of working for 90K/year staffing 5 BMT "will you please bronch," two surgery "doh why is this guy on o2 I want to send him home," and one dyspnea that is heart failure that cards won't admit consults per day, and staffing the weekend/night ICU, you can PM me. We are always looking for solid talent.

Thanks! At this point I've really drank the academic medicine kool aid so I'm definitely planning on seeing this through. It's a bit sad that what you wrote is only a slight exaggeration. There's something to be said about the flexible schedule though. Doing 80/20 is a very good way of combating burnout.

 

[jdh71]

It's 3rd year out of 4 btw, but thanks

Advice for an intern in the ICU: you won't fix the patient by sitting in front of the computer. I know we've all gotten very used to gen med floors where we get pages, put in orders, and write notes all day. Maybe you don't even see a single patient after rounds if you're not admitting. In the ICU you should get up and go to the patient's bedside more often than not when a nurse asks you for something and if they ask you to evaluate a patient you should be there in <5 min. It's also usually the only place where things can happen without an order. You treat the patient first and then the computer. Also ICU nurses have a lot more training than floor nurses, only have one or two patients (often same pt for several days in a row) and you should be including them in your discussions, explaining your thought process and contingencies, and telling them why you're doing something.

So in summary:
1. Take nurses' concerns seriously 100% of the time
2. Be present at the patient's bedside, just putting in an order doesn't cut it
3. Team based approach is key

Incidentally this is also the same formula for having the nurses like you which will in turn mean you'll have a great time in the ICU



Went into residency wanting to do ID but very quickly found out that I liked ID research more than ID clinical practice. Considered GI and cards as well but after my MICU rotation intern year I settled on PCCM. I would strongly recommend coming to the decision as early as possible. That way I was able to seek out a research mentor by the end of my intern year. If you don't take any time off after residency there is a very limited period of time before you have to apply to fellowship (August/Sept of 3rd year).



Thanks! At this point I've really drank the academic medicine kool aid so I'm definitely planning on seeing this through. It's a bit sad that what you wrote is only a slight exaggeration. There's something to be said about the flexible schedule though. Doing 80/20 is a very good way of combating burnout.

80/20 is nice work if you can get it. Hope you can.

 

[ortnakas]

@MeatTornado in my head, pulm-crit's normally a 3-year fellowship, but at any rate, thanks for the tips!

 

[235009]

@MeatTornado in my head, pulm-crit's normally a 3-year fellowship, but at any rate, thanks for the tips!

It is. 4th year (full research year) is to bolster your CV for academic career and competing for a career development grant. I'm also at a program where we do the minimum amount of clinical time required by the ACGME (18 months). The rest is all protected research time.

 

[NYCdude]

Do attendings routinely do procedures or does that become a strictly fellow thing?

 

[235009]

Do attendings routinely do procedures or does that become a strictly fellow thing?

Depends on the program of course but attendings definitely do not routinely do procedures at my program. They supervise lots though.

 

[Mad Jack]

Glad to hear you're doing so well, even if we've had our differences over the years

 

[jw3600]

I’m halfway through intern year and part of me wants training to be over. How do you trudge through PGY-Infinty and maintain sanity?

 

[NYCdude]

Depends on the program of course but attendings definitely do not routinely do procedures at my program. They supervise lots though.

Gotcha. That's a little weird then since people quote procedures as being part of the reason they want to go into pulm/crit. If you only do it for 3 years, then that doesn't really make sense lol.

 

[Dr. Death]

To work an ICU, how necessary is a critical care fellowship? Mostly required at larger hospitals or everywhere? Thanks and congrats!

 

[alprazoslam]

Anything specific besides matching into a good Im program one can do in med school in prepping for pulm/cc?

Do boards matter at all?

Thanks ahead

 

[235009]

Some great questions!

I’m halfway through intern year and part of me wants training to be over. How do you trudge through PGY-Infinty and maintain sanity?

Because the subsequent years aren't nearly as bad as intern year. Residency gets much better if your program is front-loaded. I also went to a 3+1 program which is wonderful for your mental health. With regards to fellowship the research years are pretty great with lots of flexibility. At the same time you can do some moonlighting and double your salary without much effort. Take vacation without much planning and three day weekends aren't uncommon. Also the work is stimulating: both the research and clinical stuff is interesting and something I'm passionate about.

Gotcha. That's a little weird then since people quote procedures as being part of the reason they want to go into pulm/crit. If you only do it for 3 years, then that doesn't really make sense lol.

If you're at a heavily academic place with a large fellowship then you won't do procedures but many academic places don't have fellows covering all the time because there aren't enough of them to go around! There I'm sure the attendings do a lot more procedures. At community hospitals you'd be doing all of the procedures. The experience at my program is probably only generalizable to a few programs.

To work an ICU, how necessary is a critical care fellowship? Mostly required at larger hospitals or everywhere? Thanks and congrats!

It depends on which part of the country. Some places can't find CC trained folks to cover the ICU but in hospitals in desirable locations or population centers it's required. @jdh71 may have more insight into this though.

Anything specific besides matching into a good Im program one can do in med school in prepping for pulm/cc?

Do boards matter at all?

Thanks ahead

Everything continues to matter. SURPRISE!
If you submit it with your ERAS it will be looked at and potentially scrutinized.
During an informal convo with my PD about an applicant during interview season it was brought up that the applicant's MSPE was lackluster and that this person only passed their medicine clerkship.
On the F32 grant application you have to list every grade you ever got. I know of at least one reviewer who has commented on them.

 

[jdh71]

To work an ICU, how necessary is a critical care fellowship? Mostly required at larger hospitals or everywhere? Thanks and congrats!

Much in medicine has enough nuance to drive a fire truck through. Easy is easy. Straightforward is straightforward. You train for the stuff that isn't. So yes critical care training is necessary as far as bringing the best you can to the table for patients. You'll find places that dont require it because they don't have the luxury. Is it absolutely necessary to work in every icu right now, practically speaking? No. We require it.

 

[Goro]

Did y'all ever see something like this?

NEJM - Error

 

[235009]

Did y'all ever see something like this?

NEJM - Error

Saw this pic yesterday. Completely bonkers. I don't think you'll find anyone who's seen something like this except for those who took the pic or were in the proximity when this happened!

 

[jdh71]

Did y'all ever see something like this?

NEJM - Error

Awesome.

I've pulled out a few cool casts in my day. Nothing that big. And usually in a few pieces.

 

[nimbus]

Did y'all ever see something like this?

NEJM - Error

Bet he felt a whole lot better after coughing that sucker up. He was essentially on one lung ventilation.

And only 36yo....wow.

 

[Psai]

Bet he felt a whole lot better after coughing that sucker up. He was essentially on one lung ventilation.

And only 36yo....wow.

he died a week later anyway

 

[jdh71]

he died a week later anyway

Yeah but not from his lungs. We told the gorram cardiologists its was his heart causing the dyspnea.

 

[pommes]

Great questions...
1. Research gets me out of bed in the morning. I get excited about learning something in depth and furthering the knowledge on the subject. I also want to be a leader in the field... writing and shaping the guidelines instead of just following them. I also find it fun and stimulating to work as a team to formulate and execute research questions and go to conferences. Clinical medicine has unfortunately become very tedious and has been completely ruined by administrators and meaningless metrics.

2. I started seriously pursuing research before med school. I did a 2 year MPH at a top program and published a first author pub my second year of med school (all work I did during my MPH). I then got 3 more in residency. The knowledge and skills from the MPH went a long way cause it allowed me to bring something to the table so that my mentor felt like he could invest time and effort in me. That said finding good mentors is absolutely crucial to success in research.

3. Can't really answer this because I didn't go to a "top" program. In fact didn't get interviews at any of the top programs. Basically you have to have two of the following: first quartile class rank, AOA, H in medicine clerkship with a strong letter. I had none of the three. That said you don't have to go to Brigham, MGH or Hopkins to do research in residency and match into a good fellowship. Just go to a solid University program with strong clinical training.

I'd love to be able to do what you're doing at some point. I don't have an MPH/MS or any formal research training really, just some research experience as a med student. Do you have any recs for setting yourself up to apply for grants in fellowship? Any thoughts on a (non-clinical) post-doc research fellowship after residency?

 

[235009]

I'd love to be able to do what you're doing at some point. I don't have an MPH/MS or any formal research training really, just some research experience as a med student. Do you have any recs for setting yourself up to apply for grants in fellowship? Any thoughts on a (non-clinical) post-doc research fellowship after residency?

Non-clinical post-doc research fellowships after residency are almost exclusively for people who didn't match or someone who is not qualified for a field trying to bolster their app. Don't waste your time.

The best way to set yourself up to apply for grants in fellowship is to go to a strong research fellowship that has an institutional training grant (T32) and gives you lots of protected research time. Many of my co-fellows end up doing an MS in the school of public health during fellowship as formal research training and that can be written into the grant's training plan. Grants at the fellowship level are not funding your idea, they're trying to fund people who have potential and are likely to stay in academic medicine. Good mentor(s), good institutional environment, and having demonstrated a prior interest in research.

 

[jdh71]

Non-clinical post-doc research fellowships after residency are almost exclusively for people who didn't match or someone who is not qualified for a field trying to bolster their app. Don't waste your time.

The best way to set yourself up to apply for grants in fellowship is to go to a strong research fellowship that has an institutional training grant (T32) and gives you lots of protected research time. Many of my co-fellows end up doing an MS in the school of public health during fellowship as formal research training and that can be written into the grant's training plan. Grants at the fellowship level are not funding your idea, they're trying to fund people who have potential and are likely to stay in academic medicine. Good mentor(s), good institutional environment, and having demonstrated a prior interest in research.

Best damn post I've read in a long time on academic research.

 

[pommes]

Non-clinical post-doc research fellowships after residency are almost exclusively for people who didn't match or someone who is not qualified for a field trying to bolster their app. Don't waste your time.

The best way to set yourself up to apply for grants in fellowship is to go to a strong research fellowship that has an institutional training grant (T32) and gives you lots of protected research time. Many of my co-fellows end up doing an MS in the school of public health during fellowship as formal research training and that can be written into the grant's training plan. Grants at the fellowship level are not funding your idea, they're trying to fund people who have potential and are likely to stay in academic medicine. Good mentor(s), good institutional environment, and having demonstrated a prior interest in research.

Thanks, super enlightening. My mentors are wonderful but all PhDs and suggested I ask a doc for specific advice. Guess it didn't hurt

 

[CatFactorial]

Non-clinical post-doc research fellowships after residency are almost exclusively for people who didn't match or someone who is not qualified for a field trying to bolster their app. Don't waste your time.

The best way to set yourself up to apply for grants in fellowship is to go to a strong research fellowship that has an institutional training grant (T32) and gives you lots of protected research time. Many of my co-fellows end up doing an MS in the school of public health during fellowship as formal research training and that can be written into the grant's training plan. Grants at the fellowship level are not funding your idea, they're trying to fund people who have potential and are likely to stay in academic medicine. Good mentor(s), good institutional environment, and having demonstrated a prior interest in research.

Sincere apologies for a necrobump. Saw that you had MPH and not PHD. I am reviewing successful F32 applications and general advice and just wanted to ask if F32 without a PHD is even feasible? I have a background in my proposal in the capacity of a lab tech, not a graduate student. Great institutional environment with good mentors and resources but as an applicant I'm not sure.

 

[Goro]

Sincere apologies for a necrobump. Saw that you had MPH and not PHD. I am reviewing successful F32 applications and general advice and just wanted to ask if F32 without a PHD is even feasible? I have a background in my proposal in the capacity of a lab tech, not a graduate student. Great institutional environment with good mentors and resources but as an applicant I'm not sure.

Please don't necrobump, especially when posters haven't been seen since 2018.

 

[Matthew9Thirtyfive]

Closing to head off the zombie apocalypse.